Facts and figures about physician payments

January 23, 2018

Hello Members:

There has been lots of discussion about where Alberta doctors sit compared with others in the country. I thought you might like to see some facts and figures to shed some light on how things work in Alberta. I’ll keep the words few and let the charts do the talking.

For all health expenditures per capita, Alberta is above the average, but not the highest.
Per Capita Total Provincial Government Health Expenditures by Province
Physician payments are not the main driver of high health care expenses.
Per Capita Provincial Government Health Expenditures by Use of Funds
Across all industries, Albertans are paid more. Alberta physicians must pay more for our staff than doctors in other provinces and our overhead costs are among the highest. These costs come off the top of any gross payments we receive.
Average Weekly Wages
In the next few years, population, aging and inflation (proxied by Consumer Price Index) will be the main causes of increase in our Physician Services Budget from providing more services to more Albertans. Physicians cannot control these costs.
Physician Compensation Growth Rate
For the past 30 years, the fees of Alberta physicians have provided good value and stayed in line or behind inflation and Albertans’ average weekly wages.
Alberta Relative Growth Indicies
Alberta Relative Growth Indicies
Does all this mean that we won’t do our part to control costs in the health care system? We know that Alberta’s financial difficulties are deep. What have physicians done to help out already? The answer is: Plenty. Our 2011-18 Agreement, beginning with three years of zero increases, significantly reduced the growth rate of expenditures.
Per Capita Health Spending Growth
As for the Amending Agreement 2016-18, through our stewardship of resources, we have already been extremely successful in slowing the growth rate significantly.
Physician Stewardship has Bent the Cost-curve

All these facts and figures show that one-dimensional statistics are misleading. Alberta physicians are well paid, and we have been providing excellent value. We have been collaborating with government to help control costs and came forward to do so of our own accord.

For those who continue to point fingers about gross payments, I would point out that interprovincial comparisons are tricky. They often fail to take into account things like overhead as I have already mentioned. There are also other factors in play such as: specialty mix, annual hours worked, after-hours worked, hospital-paid physicians and services and the number of physicians on alternative relationship plans (which are much less in Alberta and are not counted in most provincial fee-for-service comparisons).

Finally, Alberta physicians are national leaders in understanding payment systems and working to make them better and more reflective of modern practice. We have participated in a limited fee review as part of an overall approach to relativity. We are leading a peer review process to provide education and promote appropriate billing. We are working to understand our overhead costs as well as driving a massive initiative to understand the nature of payment distributions and find ways to close any problematic gaps that we may identify.

We are putting our own financial house in order while working with government and Alberta Health Services to promote quality and access for patients. As the Minister of Health said back in 2016: “(Physicians) have shown a willingness to partner with the government in developing solutions that will slow down the growth in health spending and improve health services for patients over the long term.”

I would be glad to know what you think. Please reach me through the usual channels:

  • Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org
  • Comment publicly below on this President’s Letter.
  • Share your perspectives with colleagues in our new Discussion Board for members only (member log in required).

At your service,
Neil D.J. Cooper, MD, FRCPC, Dip. Sport Med.
President

4 comments

Post a comment

  • #1

    Jim Lees

    Member of the public

    3:46 PM on January 23, 2018

    I find it interesting that Alberta hospital expenditures are >10% above those of BC, Ontario and Quebec. Why are hospital expenditures so comparatively higher in Alberta than in the other three largest provinces? In my experience, Alberta's main competition for physician recruitment was BC and Ontario, and these provinces were used as relevant comparators when negotiating physician compensation. The graphs provide some interesting insight into health care spending, no doubt there is more data and graphs that would contribute to further analysis. It would be interesting to hear from AHS on their interpretation and explanation of comparisons between provinces, and the overall higher cost of health care servicesin Alberta.

  • #2

    Duncan Nickerson

    Physician

    4:22 PM on January 23, 2018

    Great work compiling all of this. Physicians know this. Government and the public now need to know this.

  • #3

    John Julyan-Gudgeon

    Physician

    12:49 PM on January 24, 2018

    From what I gather in this data-set is that physicians are not the problem. Thus, for our incomes (and other "benefits") to continue to be the focus of "fixing our system" is nothing more that scapegoating. Scapegoating is merely looking for a way to villainize and victimize a group to divert attention and blame from oneselves. Further, it demonstrates a clear intent to not fix anything.

    We need to stop being the scapegoats. We need to not yield one further inch. There is no intent to "play nice" from either this government nor likely the next. We need to also stop playing in any way that could be construed as nice.

    Yield nothing. General strike if we must. And, I guarantee all of you: with current trends we will not regain any political respect without a devastatingly effect general strike.

  • #4

    Mike Kalisiak

    Physician

    11:38 AM on January 25, 2018

    Thank you for presenting the data - they do illustrate to me that we actually don't have as much room to cut physician remuneration as it was portrayed previously. I am glad that this is the AMA's message today. The last one I remember on this topic was a Tweet from AMA account last September stating that "Alberta physicians remain nation's highest paid."

    I would hope that our helping hand of $500+ M would be met with some reciprocity from the government, although according to the previous President's letter it seems that instead it is being interpreted as an indication of more "savings" to come. For some reason physicians are asked to share the risk of the rising health care costs while pretty much no other group - short perhaps of elected officials during the elections - is treated in the same way. Have we positioned ourselves appropriately for these negotiations with the Amending Agreement and its consequences???

The Alberta Medical Association stands as an advocate for its physician members, providing leadership & support for their role in the provision of quality health care.